Provider Demographics
NPI:1356529275
Name:CHAN, VIVIAN HUI-WEN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:HUI-WEN
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2505
Mailing Address - Country:US
Mailing Address - Phone:831-426-4344
Mailing Address - Fax:831-426-5223
Practice Address - Street 1:1830 41ST AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2505
Practice Address - Country:US
Practice Address - Phone:831-426-4344
Practice Address - Fax:831-426-5223
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics